A growing number of Acute Respiratory Failure (ARF) survivors are burdened by depressive symptoms and physical impairments that last for years after intensive care unit discharge. Notably, depressive symptoms are independently associated with subsequent development of new impairments in physical functioning. There are no randomized controlled trials (RCT), in ARF survivors, evaluating any intervention for depression. To improve mental and physical health outcomes in ARF survivors, the following gaps within existing patient- oriented research must be addressed: 1) interventions to improve depressive symptoms and associated physical functioning impairments, 2) evaluation of modifiable psychosocial risk factors for depressive symptoms, and 3) validation of screening instruments to assess depressive symptoms. This K23 application, by Ann Parker, MD, aims to address these gaps by designing and conducting a pilot RCT (Aim 1) of an intervention combining Behavioral Activation and physical rehabilitation (delivered via telephone and 2 home visits over 12-weeks) versus a ?usual care? control group, and evaluating its feasibility (primary outcome) and efficacy to reduce depressive symptoms and improve physical functioning (secondary outcomes). Behavioral Activation, as proposed for this pilot RCT, is an evidence-based psychological treatment for depression, which increases adaptive behaviors to achieve patient-valued goals. Using the combined patient cohort from the intervention and control groups of the RCT, Dr. Parker also will evaluate modifiable psychosocial risk factors for depressive symptoms in ARF survivors and the association between the intervention and these modifiable factors (Aim 2), and the measurement properties of two commonly used depression screening instruments in ARF survivors versus a ?gold standard? clinician diagnostic interview that she will be trained to perform (Aim 3). Dr. Parker, an Instructor in Pulmonary and Critical Care Medicine at Johns Hopkins University, has the long-term career goal of becoming an independent, NIH-funded patient-oriented researcher in ARF, focused on the intersection of mental and physical health and multidisciplinary behavioral interventions, consistent with the most recent NHLBI Strategic Vision. This award will allow Dr. Parker to achieve the following training goals: 1) obtain practical experience designing and conducting a pilot RCT; 2) undertake didactic and mentored training in psychosocial research and related behavioral interventions; 3) establish local and national collaborations with experts in mental and physical outcomes of ARF survivors; and 4) obtain preliminary data and experience to submit a successful R-level grant. Via this award, Dr. Parker will expand on her prior coursework in biostatistics and epidemiology and expand her existing mentorship team to include additional national leaders with a strong track record of fostering successful academic careers, to allow her to establish independence in investigating the unique intersection of physical and mental health outcomes in ARF.